This special supplement to JEMS, prepared in cooperation with the U.S. Metropolitan Municipalities EMS Medical Directors Consortium (aka, the “Eagles” Coalition), highlights some of the most important scientific advancements reported at the 2014 Gathering of Eagles Conference held in Dallas, Texas.
The Eagles Coalition has taken the lead in accelerating and driving the advancement of clinically proven care and resuscitation practice such as adult intraosseous (IO) infusion use in the prehospital arena, CPAP use in the field, and early STEMI and CATH lab notifications.
Eagles coordinator and course director, Dr. Paul Pepe, reflects that “the collective discussions, research and sometimes provocative initiatives carried out by the members of the group have not only advanced clinical medicine and affected countless EMS systems, but they also have substantially influenced in-hospital and emergency department care as well in terms of many changes in clinical management and procedures that were originally derived from the prehospital advances brought forth by members of the consortium.”
This JEMS EMS State of the Science supplement takes an in-depth look at significant research, advances in resuscitation practices, and the corresponding scientific data, presented at the 2014 conference. Each is the result of innovative and cutting edge processes, protocols and equipment implemented in many of the U.S. metropolitan municipalities.
In “Airway Choices Matter,” Jason McMullan, MD, and Justin Benoit, MD, take a close look at the effect of prehospital airway management on cardiac arrest outcomes.
Corey Slovis, MD, FACP, FACEP, FAAEM, and his colleagues at Vanderbilt University present “The 5 Most Important Cardiovascular Topics,” and make several key conclusions regarding various prehospital treatments and procedures, including therapeutic hypothermia, epinephrine’s role in CPR, O2 saturation levels, minimizing the pre-shock pause in CPR and the role of the prehospital ECG.
In “Resuscitating Beyond the 25-Minute Mark,” Brent Myers, MD, and key personnel from the progressive and innovative Wake County (N.C.) EMS System present significant findings and recommendations from data on successful Wake County resuscitations that should stop EMS systems from calling many cardiac arrests at the clinically-unproven 20 minute mark.
This epic article shows that good neurological outcomes are likely in survivors of prolonged resuscitations and points out that nearly 70% of survivors managed by the Wake County EMS system who were in arrest longer than 40 minutes from the time of dispatch were discharged from the hospital with a CPC of 1 or 2, and that meaningful neurological outcomes are not only possible, but in fact probable, in patients who survive cardiac arrest after extended resuscitations. In fact, the evidence from Wake County doesn’t support the concern that those who survive prolonged cardiac arrest will more than likely suffer severe neurological impairment.
In “Consistent Compressions Count!,” Joseph Holley, MD, FACEP, Joseph P. Ornato, MD, FACP, FACC, FACEP, and I present the facts and multiple case examples of how mechanical CPR is producing resuscitation results beyond expectations because of the consistency and minimal interruption in critically important blood flow these devices offer over manual CPR once activated.
The article shows the impact that the fast application and use of mechanical compression devices in Memphis (LUCAS 2) and Richmond, Va., (AutoPulse) aren’t only improving return of spontaneous circulation (ROSC) and resuscitation results but also resulting in patients who are so well perfused that they are exhibiting signs of good neurological response, blinking and answering the questions asked by paramedics during treatment and transport.
In another epic article, “A Tale of Three Successful EMS Systems,” we profile the dramatic increase in ROSC and neurologically intact discharge of patients in Wichita-Sedgwick County, Kan.; Austin-Travis County, Texas, and Wake County, N.C., as a result of highly coordinated “pit crew” resuscitation procedures.
Finally, in “Staying on Time,” Jeffrey M. Goodloe, MD, NRP, FACEP, points out the importance that count and cadence of chest compressions has on successful resuscitations. The use of inexpensive metronomes to keep personnel delivering compressions in the clinically significant range of 100–120 is pointed out in this important article.
This State of the Science supplement offers many EMS game-changing practices that should be reviewed with your medical leadership and response personnel to alter your care delivery and improve your resuscitation results.